Disabilty_Neumann cs ,:tr APPLICATION FOR BLIND OR DISABLED PERSON'S COUNTY TOWNSHIP YEAR
r ,.. DEDUCTION FROM ASSESSED VALUATION
FILED
State Form xsnotRe/sae>
Pnwaled by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to -12(b). Mat'
r JUN 9 261
INSTRUCTIONS: 812 L1 9 5)-8 .S 01--
To be filed in person or by mad with the County Audffor of the countyere the property is l,cat:..
Filing Dates: 1) Real Property:During the year for which the deduction is sought
2) Mobile Homes assessed under IC 6-1.1-7 or Manufactured Homes .. - - - • 13:118tIIIIPS1 dffit4A21'@IVtr( f months before
March 31 of each year the individual wishes to obtain the • .uciion. '/ p
See reverse side for additional instructions and qualifications- T/a 7/5 p / 11//1/
Name of applicant(owner or contract buyer) ^/ - 1/ !!p
Is applicant the legal or equitable owner? If No,what is his/her exact share of interest? If owned with someone other than spouse,
indicate with whom:
❑Yes ❑No
If name on mend is different than that of applicant,6dlvte below-
Name of contract seller
Address of contract seller(number and street,dry,state,and ZIP code) Is the property in question:
❑ Real Property ❑ gr>nuayAssessed
Mobile Home(IC 6.1.1-7)
Is applicant bard as defined in IC 12-7-2-21(1)? Is apparan disabled and unable to engage In any substantial gainful activity
as tde U edtin IC 6-1.1-12-11(d)?
❑Yes 5:1 No ID Yes 0 N
is the property used end occupied primarily for hisihm residence? Does the ar,FA'„enrs taxable gross income for the preceding calendar year
exceed$17.0007
XI Yes 0 N ❑Yes 0 N
Taxing district Key number/Legal desaiption Record number Page number
7 Y , ,-/t-36 -.00 -000- ,20/-002
UWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature of applicant Address of applicant (number and sheet,ot),,state,and ZIP code)
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